Researchers from 14 medical practices in Denmark, France, Italy, Germany, the UK, and the US have reported that physicians and nurses underestimate the incidence of delayed, chemotherapy-induced nausea and vomiting. This prospective study was supported by Merck and Company and was published in the May 15, 2004 issue of Cancer.

The 5-HT3 inhibitors are the most effective antiemetics and constitute the single greatest advance in the management of nausea and vomiting in patients with cancer. These drugs are designed to block one or more of the signals that cause nausea and vomiting. The most sensitive signal during the first 24 hours after chemotherapy appears to be 5-HT3. Blocking the 5-HT3 signal is one approach to preventing acute emesis, or emesis that is severe, but relatively short-lived. Approved 5-HT3 inhibitors include: dolasetron (Anzemet®), granisetron (Kytril®), and ondansetron (Zofran®). The newest 5-HT3 inhibitor, Aloxi® (palonosetron), has a distinct advantage over the other 5-HT3 inhibitors because, in addition to preventing acute nausea and vomiting, Aloxi® also prevents delayed nausea and vomiting, which occurs during the 2-5 days after treatment. Aloxi® is the only drug in its class that is approved by the FDA for the treatment of delayed nausea and vomiting.

The recent multi-national study involved 298 patients who were receiving chemotherapy. These patients were classified as receiving highly or moderately emetogenic doses of drugs. Over 95% of patients received 5-HT3 antagonists, almost 80% received corticosterioids and almost 80% received 2 or more antiemetic agents. Over 85% received 2 or more days of antiemetic treatment. Over half the patients receiving highly emetogenic chemotherapy had delayed nausea and vomiting. The researchers observed that delayed nausea and vomiting occurred in approximately 1/3 of patients without prior acute nausea and vomiting.

The main finding of this report is that three-quarters of the physicians and nurses underestimated the incidence of delayed nausea and vomiting in this patient population. These authors suggest that delayed nausea and vomiting continues to be a problem following chemotherapy treatment. The researchers also speculate that “the newer NK-1 antagonists and longer acting antiemetics may ameliorate these problems and help patients maintain their functional status during chemotherapy.”

Comments: This study shows that more attention needs to be paid by physicians and nurses to the problem of delayed nausea and vomiting following chemotherapy. As the authors mention, there is probably a role for newer agents, such as Aloxi® which are longer acting.

Reference: Grunberg SM, Deuson RR, Mavros P, et al. Incidence of Chemotherapy-Induced Nausea and Emesis after Modern Antiemetics. Cancer 2004;100:2261-2268.